Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are commonly comorbid, share genetic liability, and often exhibit overlapping cognitive impairments. Clarification of shared and distinct cognitive effects while considering comorbid symptoms across disorders has been lacking. In the current study, children ages 7–15 years assigned to three diagnostic groups:ADHD (n = 509), ASD (n = 97), and controls (n = 301) completed measures spanning the cognitive domains of attention/arousal, working memory, set-shifting, inhibition, and response variability. Specific processes contributing to response variability were examined using a drift diffusion model, which separately quantified drift rate (i.e., efficiency of information processing), boundary separation (i.e., speed-accuracy trade-offs), and non-decision time. Children with ADHD and ASD were impaired on attention/arousal, processing speed, working memory, and response inhibition, but did not differ from controls on measures of delayed reward discounting, set-shifting, or interference control. Overall, impairments in the ASD group were not attributable to ADHD symptoms using either continuous symptom measures or latent categorical grouping approaches. Similarly, impairments in the ADHD group were not attributable to ASD symptoms. When specific RT parameters were considered, children with ADHD and ASD shared impairments in drift rate. However, children with ASD were uniquely characterized by a wider boundary separation. Findings suggest a combination of overlapping and unique patterns of cognitive impairment for children with ASD as compared to those with ADHD, particularly when the processes underlying reaction time measures are considered separately.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
AIC = 2000.6, Sample Size Adjusted BIC = 1994.0, Vuong-Lo-Mendell-Rubin Likelihood Ratio Test for 1 versus 2 classesp < .001; Vuong-Lo-Mendell-Rubin Likelihood Ratio Test for 2 versus 3 classesp = .199
AIC = 7794.79, Sample Size Adjusted BIC = 7856.28, Vuong-Lo-Mendell-Rubin Likelihood Ratio Test for 1 versus 2 classesp = .047; Vuong-Lo-Mendell-Rubin Likelihood Ratio Test for 2 versus 3 classesp = .521
Baddeley, A. (1996). The fractionation of working memory. Proceedings of the National Academy of Sciences U S A, 93(24), 13468–13472.
Benjamini, Y., & Hochberg, Y. (1995). Controlling the false discovery rate: a practical and powerful approach to multiple testing. Journal of the royal statistical society. Series B (Methodological), 289–300.
Best, J. R., & Miller, P. H. (2010). A developmental perspective on executive function. Child Development, 81(6), 1641–1660. https://doi.org/10.1111/j.1467-8624.2010.01499.x.
Bishop, D. V. M. (2003). The Children’s Communication Checklist, Second Edition (CCC-2). London: The Psychological Corporation.
Conners, C. K. (2008). The Conners 3rd Edition (Conners 3). North Tonawanda: Multi-Health System.
Constantino, J. N., & Gruber, C. P. (2012). The social responsiveness scale, Second Edition (SRS-2). Los Angeles: Western Psychological Services.
Corbett, B. A., Constantine, L. J., Hendren, R., Rocke, D., & Ozonoff, S. (2009). Examining executive functioning in children with autism spectrum disorder, attention deficit hyperactivity disorder and typical development. Psychiatry Research, 166(2), 210–222.
Davis, N. O., & Kollins, S. H. (2012). Treatment for co-occurring attention deficit/hyperactivity disorder and autism spectrum disorder. Neurotherapeutics, 9(3), 518–530.
De Luca, C. R., Wood, S. J., Anderson, V., Buchanan, J. A., Proffitt, T. M., Mahony, K., & Pantelis, C. (2003). Normative data from the CANTAB. I: development of executive function over the lifespan. Journal of Clinical Experimental Neuropsychology, 25(2), 242–254. https://doi.org/10.1076/jcen.220.127.116.1139.
Delis, D. C., Kaplan, E., & Kramer, J. H. (2001). Delis-Kaplan Executive Function System (D-KEFS). San Antonio: The Pscyhological Corporation.
Demurie, E., Roeyers, H., Baeyens, D., & Sonuga-Barke, E. (2012). Temporal discounting of monetary rewards in children and adolescents with ADHD and autism spectrum disorders. Developmental Science, 15(6), 791–800. https://doi.org/10.1111/j.1467-7687.2012.01178.x.
Dennis, M., Francis, D. J., Cirino, P. T., Schachar, R., Barnes, M. A., & Fletcher, J. M. (2009). Why IQ is not a covariate in cognitive studies of neurodevelopmental disorders. Journal of the International Neuropsychological Society, 15(3), 331–343.
Di Martino, A., Zuo, X.-N., Kelly, C., Grzadzinski, R., Mennes, M., Schvarcz, A., & Milham, M. P. (2013). Shared and distinct intrinsic functional network centrality in autism and attention-deficit/hyperactivity disorder. Biological Psychiatry, 74(8), 623–632.
DuPaul, G., Power, T., Anastopoulos, A., & Reid, R. (1998). ADHD Rating Scale—IV: Checklists, Norms, and Clinical Interpretation. NY: Guilford Press.
Engle, R. W. (2002). Working memory capacity as executive attention. Current Directions in Psychological Science, 11(1), 19–23.
Fair, D. A., Bathula, D., Nikolas, M. A., & Nigg, J. T. (2012). Distinct neuropsychological subgroups in typically developing youth inform heterogeneity in children with ADHD. Proceedings of the National Academy of Sciences of the USA, 109(17), 6769–6774. https://doi.org/10.1073/pnas.1115365109.
Gargaro, B. A., Rinehart, N. J., Bradshaw, J. L., Tonge, B. J., & Sheppard, D. M. (2011). Autism and ADHD: how far have we come in the comorbidity debate? Neuroscience & Biobehavioral Reviews, 35(5), 1081–1088.
Geurts, H. M., Verte, S., Oosterlaan, J., Roeyers, H., & Sergeant, J. A. (2004). How specific are executive functioning deficits in attention deficit hyperactivity disorder and autism? Journal of Child Psychology and Psychiatry, 45(4), 836–854.
Goodman, R. (2001). Psychometric properties of the strengths and difficulties questionnaire. Journal of the American Academy of Child and Adolescent Psychiatry, 40(11), 1337–1345. https://doi.org/10.1097/00004583-200111000-00015.
Happe, F., Booth, R., Charlton, R., & Hughes, C. (2006). Executive function deficits in autism spectrum disorders and attention-deficit/hyperactivity disorder: examining profiles across domains and ages. Brain and Cognition, 61(1), 25–39. https://doi.org/10.1016/j.bandc.2006.03.004.
Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., & Conde, J. G. (2009). Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics, 42(2), 377–381. https://doi.org/10.1016/j.jbi.2008.08.010.
Hill, E. L. (2004). Executive dysfunction in autism. Trends in Cognitive Sciences, 8(1), 26–32. https://doi.org/10.1016/j.tics.2003.11.003.
Huang-Pollock, C. L., Karalunas, S. L., Tam, H., & Moore, A. N. (2012). Evaluating vigilance deficits in ADHD: a meta-analysis of CPT performance. Journal of Abnormal Psychology, 121(2), 360–371. https://doi.org/10.1037/a0027205.
Hulst, B. M., Zeeuw, P., Bos, D. J., Rijks, Y., Neggers, S. F., & Durston, S. (2017). Children with ADHD symptoms show decreased activity in ventral striatum during the anticipation of reward, irrespective of ADHD diagnosis. Journal of Child Psychology and Psychiatry, 58(2), 206–214.
Insel, T., Cuthbert, B., Garvey, M., Heinssen, R., Pine, D. S., Quinn, K., & Wang, P. (2010). Research domain criteria (RDoC): toward a new classification framework for research on mental disorders. The American Journal of Psychiatry, 167(7), 748–751. https://doi.org/10.1176/appi.ajp.2010.09091379.
Kane, M.J., Conway, A., Hambrick, D.Z., & Engle, R.W. (2007). Variation in working memory capacity as variation in executive attention and control Variation in Working Memory (pp. 21–48).
Karalunas, S. L., Geurts, H. M., Konrad, K., Bender, S., & Nigg, J. T. (2014). Annual research review: Reaction time variability in ADHD and autism spectrum disorders: measurement and mechanisms of a proposed trans-diagnostic phenotype. Journal of Child Psychology and Psychiatry, 55(6), 685–710. https://doi.org/10.1111/jcpp.12217.
Karalunas, S. L., Gustafsson, H. C., Dieckmann, N., Tipsord, J., Mitchell, S. H., & Nigg, J. T. (2017). Heterogeneity in development of aspects of working memory predicts longitudinal ADHD symptom change. Journal of Abnormal Psychology, 126(6), 774.
Karalunas, S. L., & Huang-Pollock, C. L. (2013). Integrating impairments in reaction time and executive function using a diffusion model framework. Journal of Abnormal Child Psychology, 41(5), 837–850. https://doi.org/10.1007/s10802-013-9715-2.
Kofler, M. J., Rapport, M. D., Sarver, D. E., Raiker, J. S., Orban, S. A., Friedman, L. M., & Kolomeyer, E. G. (2013). Reaction time variability in ADHD: A meta-analytic review of 319 studies. Clinical Psychology Review, 33(6), 795–811.
Logan, G. (1994). On the ability to inhibit thought and action: A users' guide to the stop signal paradigm. In D. Dagenbach & T. H. Carr (Eds.), Inhibitory processes in attention, memory, and language (pp. 189–239). San Diego: Academic Press.
Lord, C., Rutter, M., DiLavore, P. C., & Risi, S. (2001). Autism Diagnostic Observation Schedule (ADOS). Los Angeles: Western Psychological Services.
McDonald, J. H. (2014). Handbook of Biological Statistics (3rd ed.). Baltimore: Sparky House Publishing.
Miller, M., Loya, F., & Hinshaw, S. P. (2013). Executive functions in girls with and without childhood ADHD: developmental trajectories and associations with symptom change. Journal of Child Psychology and Psychiatry, 54(9), 1005–1015.
Miodovnik, A., Harstad, E., Sideridis, G., & Huntington, N. (2015). Timing of the diagnosis of attention-deficit/hyperactivity disorder and autism spectrum disorder. Pediatrics, 136(4), e830–e837.
Mitchell, S. H. (1999). Measures of impulsivity in cigarette smokers and non-smokers. Psychopharmacology, 146(4), 455–464.
Mitchell, S. H., Wilson, V. B., & Karalunas, S. L. (2015). Comparing hyperbolic, delay-amount sensitivity and present-bias models of delay discounting. Behavioural Processes, 114, 52–62.
Musser, E. D., Hawkey, E., Kachan-Liu, S. S., Lees, P., Roullet, J. B., Goddard, K., & Nigg, J. T. (2014). Shared familial transmission of autism spectrum and attention-deficit/hyperactivity disorders. Journal of Child Psychology and Psychiatry, 55(7), 819–827. https://doi.org/10.1111/jcpp.12201.
Nigg, J., Willcutt, E. G., Doyle, A. E., & Sonuga-Barke, E. J. S. (2005). Causal Heterogeneity in Attention-Deficit/ Hyperactivity Disorder: Do We Need Neuropsychologically Impaired Subtypes? Biological Psychiatry, 57(11), 1224–1230.
Nigg, J. T. (1999). The ADHD response-inhibition deficit as measured by the stop task: Replication with DSM-IV combined type, extension, and qualification. Journal of Abnormal Child Psychology, 27(5), 393–402.
Nigg, J. T. (2000). On inhibition/disinhibition in developmental psychopathology: views from cognitive and personality psychology and a working inhibition taxonomy. Psychological Bulletin, 126(2), 220–246.
Nigg, J. T., Hinshaw, S. P., & Halperin, J. M. (1996). Continuous performance test in boys with attention deficit hyperactivity disorder: Methylphenidate dose response and relations with observed behaviors. Journal of Clinical Child Psychology, 25(3), 330–340.
Nyden, A., Niklasson, L., Stahlberg, O., Anckarsater, H., Wentz, E., Rastam, M., & Gillberg, C. (2010). Adults with autism spectrum disorders and ADHD neuropsychological aspects. Research in Developmental Disabilities, 31(6), 1659–1668. https://doi.org/10.1016/j.ridd.2010.04.010.
Ozonoff, S., & Jensen, J. (1999). Brief report: specific executive function profiles in three neurodevelopmental disorders. Journal of Autism and Developmental Disorders, 29(2), 171–177.
Pennington, B. F., & Ozonoff, S. (1996). Executive functions and developmental psychopathology. Journal of Child Psychology and Psychiatry. Special Issue: Annual research review, 37(1), 51–87.
Pirrone, A., Dickinson, A., Gomez, R., Stafford, T., & Milne, E. (2017). Understanding perceptual judgment in autism spectrum disorder using the drift diffusion model. Neuropsychology, 31(2), 173.
Puig-Antich, J., & Ryan, N. (1986). Kiddie schedule for affective disorders and schizophrenia. Pittsburgh: Western Psychiatric Institute.
Ratcliff, R. (2002). A diffusion model account of response time and accuracy in a brightness discrimination task: fitting real data and failing to fit fake but plausible data. Psychonomic Bulletin & Review, 9(2), 278–291. https://doi.org/10.3758/BF03196283.
Ratcliff, R. (2006). Modeling response signal and response time data. Cognitive Psychology, 53(3), 195–237. https://doi.org/10.1016/j.cogpsych.2005.10.002.
Ratcliff, R., & Rouder, J. N. (2016). Modeling response times for two-choice decisions. Psychological Science, 9(5), 347–356. https://doi.org/10.1111/1467-9280.00067.
Raymaekers, R., Antrop, I., van der Meere, J. J., Wiersema, J. R., & Roeyers, H. (2007). HFA and ADHD: a direct comparison on state regulation and response inhibition. Journal of Clinical and Experimental Neuropsychology, 29(4), 418–427. https://doi.org/10.1080/13803390600737990.
Rommelse, N., Geurts, H., Franke, B., Buitelaar, J., & Hartman, C. (2011). A review on cognitive and brain endophenotypes that may be common in autism spectrum disorder and attention-deficit/hyperactivity disorder and facilitate the search for pleiotropic genes. Neuroscience & Biobehavioral Reviews, 35, 1363–1396.
Rommelse, N. N., Franke, B., Geurts, H. M., Hartman, C. A., & Buitelaar, J. K. (2010). Shared heritability of attention-deficit/hyperactivity disorder and autism spectrum disorder. European Child & Adolescent Psychiatry, 19(3), 281–295. https://doi.org/10.1007/s00787-010-0092-x.
Ronald, A., Larsson, H., Anckarsäter, H., & Lichtenstein, P. (2014). Symptoms of autism and ADHD: A Swedish twin study examining their overlap. Journal of Abnormal Psychology, 123(2), 440.
Ronald, A., Simonoff, E., Kuntsi, J., Asherson, P., & Plomin, R. (2008). Evidence for overlapping genetic influences on autistic and ADHD behaviours in a community twin sample. Journal of Child Psychology and Psychiatry, 49(5), 535–542. https://doi.org/10.1111/j.1469-7610.2007.01857.x.
Rutter, M., Le Couteur, A., & Lord, C. (2003). Autism Diagnostic Interview–Revised (ADI-R). Los Angeles: Western Psychological Services.
Sagvolden, T., Aase, H., Zeiner, P., & Berger, D. (1998). Altered reinforcement mechanisms in attention-deficit/hyperactivity disorder. Behavioural and brain research, 94(1), 61–71. https://doi.org/10.1016/S0166-4328(97)00170-8.
Sanders, J., Johnson, K. A., Garavan, H., Gill, M., & Gallagher, L. (2008). A review of neuropsychological and neuroimaging research in autistic spectrum disorders: Attention, inhibition and cognitive flexibility. Research in Autism Spectrum Disorders, 2(1), 1–16.
Sanislow, C. A., Pine, D. S., Quinn, K. J., Kozak, M. J., Garvey, M. A., Heinssen, R. K., & Cuthbert, B. N. (2010). Developing constructs for psychopathology research: research domain criteria. Journal of Abnormal Psychology, 119(4), 631–639. https://doi.org/10.1037/a0020909.
Semrud-Clikeman, M., Walkowiak, J., Wilkinson, A., & Butcher, B. (2010). Executive functioning in children with Asperger syndrome, ADHD-combined type, ADHD-predominately inattentive type, and controls. Journal of Autism and Developmental Disorders, 40(8), 1017–1027. https://doi.org/10.1007/s10803-010-0951-9.
Sinzig, J., Bruning, N., Morsch, D., & Lehmkuhl, G. (2008). Attention profiles in autistic children with and without comorbid hyperactivity and attention problems. Acta Neuropsychiatrica, 20(4), 207–215.
Unsworth, N., & Engle, R. W. (2007). The nature of individual differences in working memory capacity: active maintenance in primary memory and controlled search from secondary memory. Psychological Review, 114(1), 104–132. https://doi.org/10.1037/0033-295X.114.1.104.
van der Meer, J. M., Oerlemans, A. M., van Steijn, D. J., Lappenschaar, M. G., de Sonneville, L. M., Buitelaar, J. K., & Rommelse, N. N. (2012). Are autism spectrum disorder and attention-deficit/hyperactivity disorder different manifestations of one overarching disorder? Cognitive and symptom evidence from a clinical and population-based sample. Journal of the American Academy of Child and Adolescent Psychiatry, 51(11), 1160–1172 e1163. https://doi.org/10.1016/j.jaac.2012.08.024.
van Mourik, R., Oosterlaan, J., & Sergeant, J. A. (2005). The Stroop revisited: a meta-analysis of interference control in AD/HD. Journal of Child Psychology and Psychiatry, 46(2), 150–165. https://doi.org/10.1111/j.1469-7610.2004.00345.x.
Voss, A., & Voss, J. (2007). Fast-dm: a free program for efficient diffusion model analysis. Behavior Research Methods, 39(4), 767–775. https://doi.org/10.3758/BF03192967.
Willcutt, E. G., Doyle, A., Nigg, J. T., Faraone, S. V., & Pennington, B. F. (2005). Validity of the executive function theory of attention-deficit/hyperactivity disorder: A meta-analytic review. Biological Psychiatry, 57(11), 1336–1346. https://doi.org/10.1016/j.biopsych.2005.02.006.
Wilson, V. B., Mitchell, S. H., Musser, E. D., Schmitt, C. F., & Nigg, J. T. (2011). Delay discounting of reward in ADHD: application in young children. Journal of Child Psychology and Psychiatry, 52(3), 256–264. https://doi.org/10.1111/j.1469-7610.2010.02347.x.
Yerys, B. E., Kenworthy, L., Jankowski, K. F., Strang, J., & Wallace, G. L. (2013). Separate components of emotional go/no-go performance relate to autism versus attention symptoms in children with autism. Neuropsychology, 27(5), 537.
This project was supported by Simons Foundation #177894 and by National Institutes of Health R01 MH096773 (Fair), R00MH091238 (Fair), R01 MH086654 (Nigg), R37 MH059105 13 (Nigg), and K23 MH108656 (Karalunas). We thank Corinne Stevens, Libby Nousen, and Andrew Bontemps for assistance with data collection and preparation. We gratefully acknowledge the participants and their caregivers, as well as the graduate students, staff, and research assistants whose remarkable dedication has made this research possible.
Conflict of Interest
The authors have no conflicts of interest or financial disclosures to report.
All procedures were approved by the Oregon Health & Science University’s Institutional Review Board.
Parents provided written informed consent and children provided written assent.
Electronic Supplementary Material
Rights and permissions
About this article
Cite this article
Karalunas, S.L., Hawkey, E., Gustafsson, H. et al. Overlapping and Distinct Cognitive Impairments in Attention-Deficit/Hyperactivity and Autism Spectrum Disorder without Intellectual Disability. J Abnorm Child Psychol 46, 1705–1716 (2018). https://doi.org/10.1007/s10802-017-0394-2
- Attention-deficit/hyperactivity disorder (ADHD)
- Autism spectrum disorders (ASD)
- Executive function
- Reaction time variability
- Diffusion model